Elevated CRP inflammation markers

wonderoushope

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Hi there,

Just got results from GP and everything looks good, but as usual CRP markers are always elevated. It has never gone below the healthy reference range of (<5). In the year 2007 CRP= 27H (at an all-time high) and between 2014-2019 it always sits between 7-8

I just looked at my ESR markers over the years too
ESR 2006=15H 2009=24H 2011=21H 2012=22H 2016 =13,9,9,5 in 2016=9 mm/hr (units) reference (3-12)

All GP's and specialist find it odd my CRP never goes below 5 but because it doesn't change much they are not concerned. But this is the only thing that gives me an indication my body might have some constant inflammation. Everything else comes back really good. Is it true because my CRP no longer jumps that there is nothing to be investigated? It's the only little nugget to say something isn't quite right in my body.

Can that elevated CRP just be something like IBS?
 
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Pyrrhus

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I find it somewhat odd that your doctors are not interested in finding the cause of your chronic inflammation.

CRP is perhaps the most widely-accepted marker of inflammation. Most ME patients don’t even see any elevation in CRP despite inflammatory symptoms.

Perhaps your doctors just don’t know where to start looking.
 

used_to_race

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IBS isn't associated with elevated CRP. If you have GI symptoms you should look into a test such as calprotectin which is pretty sensitive for IBD, but you'd need a colonoscopy to get it diagnosed. High ESR is also suggestive of a more traditional rheumatologic condition. Do you experience any joint pains? Also, it seems like your markers were higher around 10 years ago and have now become a bit lower. Have your symptoms also improved concurrently? I would seriously look into a condition like Undifferentiated Connective Tissue Disease (UCTD) and talk to a rheumatologist about getting on Plaquenil. Have you had your ANA tested? Rheumatoid Factor?
 

wonderoushope

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@Pyrrhus - From what I understand my markers although elevated isn't chronic anymore. I think my doctor said they would start investigating over 10 and if it was jumping a lot, but because it has stayed the same (although elevated) over the years they are not too concerned. It was very high in 2007 but for the last 5 years at least it has been much lower.

@used_to_race - Hmm, it's just a read an article that said CRP can be increased because of IBS. It was not a very well respected site, so it probably wasn't correct. I've had calprotectin test.

My Calprotectin 48 mg/kg (<50)
Comments on Collection 06/08/14 N/A:
Elevated faecal calprotectin indicates a high probability of intestinal inflammation. Levels of faecal calprotectin above 250 mg/kg have greater positive predictive value especially in children. For patients with known
inflammatory bowel disease in remission, faecal calprotectin above 50 mg/kg is associated with an increased risk of relapse over the next 12 months.
In patients with a faecal calprotectin levels below 50 mg/kg with strong clinical indications of intestinal inflammation, a repeat sample may be useful. In small bowel Crohn's the faecal calprotectin may be within the normal range.
Hmm, maybe I should get it redone as it was just below 50. I am surprised my gastro didn't ask to do it again. In 2016 I got a colonoscopy and gastroscopy with biopsies taken by the same gastroenterologist. The pathology results showed low-grade chemical gastritis. Could my CRP be connected to continuing gastritis?

Do you experience any joint pains?
Yes it jumps around between muscle and joint pain. I am seeing a rheumatologist next week. GP has already done RA test (negative) and GP thought maybe axial spondyloarthropathy but so far looking like it isn't that as HLA-B27 test came back negative too.

Have your symptoms also improved concurrently?
No, not really. They are flaring up at the moment, that's why I went to GP and thought it would be good to see rheumatologist whilst issue is flaring up (I see the rheumatologist next week) . I get migratory pain issues/flare ups. At the moment I wake up with sore thumbs, really stiff legs, muscle pain near inner knees, calf muscle pain (which can last months and disappears and the reappears), lower and upper back pain. I also get flare-ups of costochondritis, use to get what seemed to be plantar fasitis (but disappeared for the time being), short bursts of numbness in hands and arms, pins and needles in fingers especially when I just wake-up, my jaw area near ear is tender, and hurts if I accidentally itch it (but doesn't hurt otherwise) . It seems to just circulate and change within my body over the year. In the past the joint pain has been in feet etc It's all pretty bearable, but I think it adds to my fatigue.

I have had a Brain MRI and a MRI Cervico - Thoracic Spin performed in late Dec 2016. I have small disc protrusion/extrusion in the cervical and thoracic spine. I was mainly to check if I had MS. I don't.
 
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used_to_race

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Hmm, maybe I should get it redone as it was just below 50. I am surprised my gastro didn't ask to do it again. In 2016 I got a colonoscopy and gastroscopy with biopsies taken by the same gastroenterologist. The pathology results showed low-grade chemical gastritis. Could my CRP be connected to continuing gastritis?
Calprotectin anywhere below 100 isn't a concern. I looked into this pretty seriously because I had an elevated result (around 170), but in active Crohn's it's more like 300-500, and usually even higher in UC. Since you also had a negative colonoscopy (tons of healthy people have gastritis), I don't think you would be likely to have IBD. IBS could be a concern depending on your symptoms but I'm not as familiar with that.

Yes it jumps around between muscle and joint pain. I am seeing a rheumatologist next week. GP has already done RA test (negative) and GP thought maybe axial spondyloarthropathy but so far looking like it isn't that as HLA-B27 test came back negative too.
The pain and elevated inflammatory markers are definitely a concern. I would have a serious discussion with the rheumy and ask for ANA, full lupus panel, full antiphospholipid panel, etc. Also specific tests for dermatomyositis and scleroderma. Maybe a nerve biopsy to look for small fiber neuropathy given your numbness issues. Just an exhaustive rheumatological workup. I would also just ask if you can start plaquenil based on the factors already mentioned. You seem to meet the (subjective) criteria for UCTD and a good amount of people are on plaquenil as a first line for that and doing better, so it's worth a try.
 
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This thread is interesting to me. My CRP is on range, but my doctor asked for the highly sensitive CRP (which I think is different) and they found I have hidden inflammation (1,86). He asked for Calprotectin too, so we could know if that inflammation was coming from the gut, but seems it does not (it was 16). Where my inflammation comes from it's still a mystery.

My RF is 14 since the beginning of my last relapse and it has not moved a bit even if I have way less joint pain. Seems like there's no way to bring it down.

My ESR was over range several months ago, but I discovered I had mycoplasma genitalium and, after the treatment with oral antibiotics, the ESR came down significantly on range.

@wonderoushope Have you found any possible active infection?
 

wonderoushope

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Thanks @used_to_race for your feedback. I will run your suggestions past rheumatologist. However, I was just looking over my results for things in the last couple of days and hadn't really thought much about my MRI results from a few years ago. Basically, my GP said I just had "worn discs" from the neck to middle back (and she thinks lower but that part wasn't tested) and that's why I would be getting back pain and migraines. I had forgotten about my worn discs and I guess that could increase migratory pain in the body? Like if my back is hurting then maybe my muscles in my calves have to work harder, hence muscle pain? I am just thinking out loud here. However, it still concerns me I seem to have cartilage type issues, like costochondritis, jaw type pain I suspect I have TMJ and in the past planter fascitis kind of a pain in the foot. Plus my thumbs and inner knees are painful to touch at the moment.

Attached is my MRI results in case you are interested. I am wondering if you think there is anything in those results that I should ask rheumatologist about? They will get these results and hopefully also the scans. I am just wondering if he is going to say a lot of my issues is from just worn discs :( But I have to remember I have had so many other symtoms other than pains in body, like food intolerances, nausea, chemical sensitivities, increased anxiety, sleep issues etc
 

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@poetessinmotion - not so far. My GP has done lots of bloods, but I am not sure if those bloods were for possible infection. Do you know what sort of tests my GP would have requested for active infections?
Well, you have the whole bunch of bugs that could be a factor for ME, but sometimes infections are not so easy to find and target. In my case, it was my gynecologist who found out I had an active mycoplasma infection (I thought it was only a very bad candida flare). As for the rest of virus / bacteria, I haven't found anything conclusive yet.

I find the roadmap for testing and treatment you can find on this site very useful regarding tests for viruses: https://sites.google.com/site/cfstestingandtreatmentroadmap/
 

used_to_race

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@wonderoushope Sorry but I'm not able to interpret MRI results or imagery. You're raising reasonable points regarding the connectedness of the musculoskeletal system but you shouldn't let any doctors dismiss you based on vague things like worn discs. If I were in your shoes, I'd be asking to try plaquenil (can take months to kick in) or even a short course of prednisone (works within a day or so, can't stay on it long-term) just to figure out if there is any connection between the inflammation and the symptoms you are feeling. What you are describing cannot be explained away and you deserve to try these first-line treatments and see if they will help you.
 

wonderoushope

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Thanks @used_to_race for your valuable feedback. I'm disappointed that the worn discs were not thought about some more. I think a lot of it could be interconnected, but also my fault for not thinking about it some more. I now have a bit more insight into what I should ask rheumatologist. Thanks so much for your advice :)